17. Name It - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
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17. Name It

Therapist Resources > Therapy Books > Therapy! What's Therapy?

While Carson may have been a crude aggressor, Vee was an eloquent aggressor.  Both dynamics- behaviors need to be named by their therapist.  With an undercover or subversive aggressor, therapeutic effectiveness determines whether to initially explore the underlying issues beneath the behavior and feelings.  With Carson, boundaries were set after the therapeutic process of exploring his individual dynamics.  For Vee, identifying her dynamic and setting boundaries can come first.  Both members of a couple usually try to present themselves in the best light possible to therapists.  While one partner is often more volatile and less able to hide his or her aggression, the other partner may be quite adept at presenting a reasonable front.  It is relatively easy to play innocent when the partner such as Carson is so demonstrative or stereotypically emotionally male.  If the therapist fails to expose her strategy, it allows Vee to maintain the dysfunctional mythology with her identified as the "good gal" and Carson as the "bad guy."  As long as she holds on to this dichotomy of good and evil, she must morally pathologize Carson.  This makes him unable to fully take responsibility for his negative behavior.  If Carson takes responsibility (that is, owning "respond ability," the ability to respond), he experiences it as admitting that he is the "bad guy."  Since he already has instincts from male socialization, his corporate rat race, and his father's competition with him, the idea of losing is already an anathema to him.  With Vee framing it also as a competition for moral supremacy within the couple, Carson experiences revealing vulnerability as giving ammunition to his enemy.  Making it safe for him to go deeper into his own process depends in part on Vee being compassionate rather than opportunistic with his revelations.  The therapist has experienced facilitated a partner to reach into his or her soul and withdraw deep childhood experiences of pain and trauma, only to have the other partner violate the vulnerability with judgment, distain, or dismissal.  Deeper characterological issues such as narcissism may curtail empathy.

In less severe couples, the recommendation to identify the purser-distancer characteristic of some couples can be applied to other problematic dynamics of other couples.  "Following a period of observation and/or when the therapist feels confident enough in his or her assessment, it is recommended that he or she label the pursuer-distancer interaction for clients. Doing so makes it easier for them to recognize the pattern, gives them something tangible to work on, and tends to increase their self-confidence in terms of alleviating it.  Labeling also aids in balancing the couple, and helps them to see the problem as systemic in nature, rather than blaming one another for the problem.  The therapist should label this style immediately after it is enacted, and continue to do so throughout treatment whenever the couple are in this specific interactional mode" (page 20)

By ignoring or dismissing Carson with a "Whatever…," Vee purposely attacks him at his greatest vulnerability.  It was vicious!  It is highly characteristic of individuals who've had a history of abuse personally or whose communities have had histories of oppression and being marginalized, to resort to passive-aggressive behavior in order to fight back.  Overt acts of aggression are far too dangerous for a disempowered individual of a family or of a society.  Vee was disempowered in her family-of-origin and she fears being disempowered in the couple.  Her responses are intensified because of a moral righteousness, justifying to herself her behavior as being defensive and retaliatory.  While she may maintain her mythology as not "really" being hurtful, she is nevertheless incredibly adept at destroying Carson's ego.  Such behavior should be identified as vicious and aggressive, which the therapist can only do by avoiding over-identification with the "poor victim".  An essential part of this therapeutic strategic lies in the therapist breaking the pattern of Carson being the aggressive bad guy, Vee being the poor victim, deserving of sympathy and support and retaliating passive-aggressively, Carson feeling unjustly punished and responding aggressively, Vee repeating, and so on and so forth.  She is aggressive subtly with plausible deniability, especially to less observant therapists, friends, or family members.  He is effectively ignited and "bad," although he feels been abused as well.  

When the therapist acknowledges Carson's feelings of being attacked, it identified her aggressions and attacked her mythology as being helpless.  Acknowledging his pain attacked the distortion that his anger is unfounded.  He "wins" the battle not to dominate her, but the battle for validation.  His humanity is acknowledged, while he is confronted for often behaving outrageously.  The focus of therapy then can shift to do more individual work with Vee.  However, Isakson et al (2006) has some significant cautions regarding individual versus couple therapy relative to men and women.  As stated earlier, Isakson et al found outcomes for men tended to be comparable in individual therapy versus couple therapy.  In addition, both individual and couple therapy were equally beneficial regardless of men's different levels of clinical disturbance.  This is not the case for women.  "In contrast, when a female entered couple therapy in the clinical range and her male partner did not, she had a poor outcome relative to married females seen in individual therapy and females seen in couple treatment when both partners were equally disturbed… Were these findings replicated it would make sense to assess the level of functioning of both members of a couple before initiating treatment and refer females to individual therapy if their partner is not also scoring within clinical levels of disturbance.  In this regard discrepant level of disturbance would be considered a contraindication for couple treatment.  At the very least, females who enter couple treatment with a non-distressed partner should have their treatment response carefully monitored so that the clinician could intervene in a timely fashion in the case of a poor treatment response" (page 319).

Vee would need to be assessed to determine if her degree of emotional or clinical disturbance were comparable to Carson's.  If they were comparable, then couples therapy should be useful.  However, if she were, when compared to Carson significantly more vulnerable, traumatized, or suffered from some intense condition such as bipolar disorder, substance dependency, or a personality disorder, according to Isakson et al, couple therapy may not be a good approach to help her individually or as part of the couple.  Her individual and relationship needs might be better met with individual therapy.  Men with higher disturbance than their female partners did not experience the same negative effect in couple therapy.  Since they found a clear gender difference, the therapist might speculate that higher disturbance when accompanied by other gender defined socio-cultural influences create too complex and intense a situation- possibly negatively prejudicial for some women in couple therapy.  Per their caution to carefully monitor disturbed females who enter couples therapy with a non-distressed male partner, the therapist took extra care to continually assess Vee's level of psychological composure while managing interventions with Vee and Carson.  Vee responded very well to the therapist's challenging intervention that affirmed Vee's power in the relationship, albeit through an ultimately dysfunctional process.  She was receptive to being prompted in therapy to own her clever strategy for the illusion of power and control and its ensuing corrupting effect on the relationship.  The therapist validated Vee for her ingenuity to come up with such a powerful strategy in the face of the family-of-origin oppression she experienced.  Individual work with Vee, while Carson observed helped her connect to the desperation she felt as the as a virtually powerless member of her family.  She revealed that she learned passive-aggressive behavior from her mother's model.  Her father had dominated her mother.  He was way too volatile to confront directly, so feigned simple-mindedness, "forgetting," and making "mistakes" was how Vee's mom fought back.  The therapist honored the sad little girl from her childhood.  Vee's alliance with the therapist strengthened with this therapeutic compassion, just as the process with Carson increased that alliance.  That both of them have a strong alliance with the therapist is crucial to subsequent work.  "If both partners have a strong alliance with the therapist by the third session, the likelihood of a positive outcome may be enhanced. However, when the partners agree that the alliance is weak, a poor outcome is more probable.  Finally, when the partners disagree on the strength of the alliance, the outcome appears to be more unpredictable" (Symonds, 2004, page 452).

Carson and Vee could now have empathy for each other.  They had both revealed deep vulnerabilities.  Only with insight and ownership of her process and Carson's compassion for Vee, the little girl and her helplessness, could she then become engaged in mechanisms for more overt and healthy self-empowerment.  This includes Vee learning how to "fight" overtly and more honestly.  Therapy prompted her that she can take more direct ownership of her power in the relationship.  This would be a major change in her personal worldview.  It would be a major psychic and cultural shift from having been a disempowered child in her family and a disempowered partner in the marriage.  Vee could then join Carson in a mutual process for intimacy as a couple. That also would be a major psychic and cultural shift since power and control in her close communities had always had one dominating and the other(s) being dominated, and never equal.  Similar to many other couples, Carson and Vee had other powerful issues that their therapist had to consider, including personality disorders, substance abuse, history of trauma, child abuse, domestic violence, and so forth.  

3056 Castro Valley Blvd., #82
Castro Valley, CA 94546
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
office: (510) 582-5788
fax: (510) 889-6553
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